Chapter 106 Targeted Case Management - Alabama Medicaid Agency

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Targeted Case ManagementNeeds assessmentA TCM provider performs a written comprehensive assessment of therecipient’s assets, deficits, and needs. The TCM provider gathers thefollowing information:• Identifying information• Socialization and recreational needs• Training needs for community living• Vocational needs• Physical needs• Medical care concerns• Social and emotional status• Housing and physical environment• Resource analysis and planningCase planningTCM providers must develop a systematic, recipient-coordinated plan of carethat lists the actions required to meet the identified needs of the recipientbased on the needs assessment. The plan is developed through acollaborative process involving the recipient, his family or other supportsystem, and the case manager. It must be completed in conjunction with theneeds assessment within the first 30 days of contact with the recipient.Service arrangementThrough linkage and advocacy, the case manager coordinates contactsbetween the recipient and the appropriate person or agency. These contactsmay be face to face, phone calls, or electronic communication.Social SupportThrough interviews with the recipient and significant others, the case managerdetermines whether the recipient possesses an adequate personal supportsystem. If this personal support system is inadequate or nonexistent, the casemanager assists the recipient in expanding or establishing such a networkthrough advocacy and linking the recipient with appropriate persons, supportgroups, or agencies.Reassessment and Follow-upThrough interviews and observations, the case manager evaluates therecipient’s progress toward accomplishing the goals listed in the case plan atintervals of six months or less. In addition, the case manager contactspersons or agencies providing services to the recipient and reviews theresults of these contacts, together with the changes in the recipient’s needsshown in the reassessments, and revises the case plan if necessary.106-6 January 2011
Targeted Case Management 106MonitoringThe case manager determines what services have been delivered andwhether they adequately meet the needs of the recipient. The plan of caremay require adjustments as a result of monitoring.106.2.2 Target Group DefinitionsThis section defines the eight target groups served by TCM providers.Target Group 1 – Mentally Ill AdultsTarget Group 1 consists of functionally limited individuals age 18 and overwith multiple needs who require mental health case management. Suchpersons have a DSM-III-R diagnosis (other than mental retardation orsubstance abuse), impaired role functioning, and a documented inability toindependently access and sustain involvement with needed services.Target Group 2 – Mentally Retarded AdultsTarget Group 2 consists of individuals who are 18 years of age or older with adiagnosis of mental retardation, as defined by the American Association ofMental Retardation (formerly AAMD). The individual’s diagnosis must bedetermined by a Qualified Mental Retardation Professional (QMRP) and mustinclude a primary determination of both intellectual and adaptive behaviorsindicating the individual's primary problems are due to mental retardation.Such persons may have other or secondary handicapping conditions.Target Group 3 – Handicapped ChildrenTarget Group 3 consists of individuals, age 0-21 considered to behandicapped as defined in the following six subgroups:• Mentally retarded/related conditions• Seriously emotionally disturbed• Sensory impaired• Disabling health condition(s)• Developmentally delayed• Multi-handicappedMentally Retarded/Related ConditionsAll recipients in this subgroup must be age 0-17. A recipient is consideredmentally retarded when a diagnosis of mental retardation is determined. Thisdetermination must include a primary determination of both intellectual andadaptive behaviors indicating the individual's primary problems are due tomental retardation.January 2011 106-7
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Chapter 106 Targeted Case Management - Alabama Medicaid Agency

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